Seattle Post-Interlligencer Reporter

Wednesday, January 29, 2003

January 28, 2003

In her autobiography, "I'm the One That I Want," Korean American comedian Margaret Cho detailed the days she was ordered to consume only one small bag of rice per week, chewing every bite 50 times, as part of a diet her uncle recommended. He shipped the instructions via registered mail, making sure Cho signed for it, and even faxed another copy to make sure she got the message.

Cho already had exercised, abused laxatives and Fen-Phen and lost 30 pounds in two weeks after pressure from ABC (which aired her sitcom, "All-American Girl," from 1994-95) and reporters who described her as "thunder thighs." But her relatives, obsessed over her TV image, continued their assault, inquiring about her weight before saying hello and relating stories of women who never got married because they didn't lose the pounds. Cho believed she couldn't be accepted for her non-dainty figure.

"I have never been a heavy person, but for some reason, my physique drives some Korean people insane. They feel that I am too large for them to be comfortable, too large to be one of them," she writes. "Any time I meet a Korean person, it is most likely that we will make one of the comments I have outlined. It is not a joke."

Far from it. Gone are the after-school specials in which the only teenagers whittling down to gaunt proportions from anorexia nervosa and bulimia (the two most common eating disorders) are white Americans. Recent studies are finding that the country's ethnic populations also are falling into the dangers of starving or purging and that health practitioners are ill-equipped to deal with this revelation. Black and Hispanic women, long thought to be the most accepting of fuller figures, are diagnosed with eating disorders as frequently as white women. And Asian American women, incorrectly assumed to be content with their petite bodies, are harboring some secret battles of their own.

Not beautiful = not 'American'

No matter how long they've lived here, Asians living in America tend to define beauty by what they view as the Caucasian ideal -- thin, blond, blue-eyed. Social psychologist Christine Iijima Hall, author of the 1995 journal article "Asian Eyes: Image and Eating Disorders of Asian and Asian American Women," found that many Asian Americans and other minorities fall vulnerable to eating disorders the more they assimilate into white culture because they appear further from this "ideal beauty" than white women.

Ming Nagasawa was the only Asian American girl in her suburban Ohio junior high school. Looking around, she saw her physical differences -- eyes that were small and dark brown, hair that was black -- as social death. The boys stayed away. She began to imagine that if her frame was thinner, her eyes would appear larger, she would be more popular. She would look more American.

"For girls trying to navigate their way in a social world where the homecoming queen is always thin, beautiful and white, figuring out what it means to be beautiful as an Asian woman is difficult and confusing," she said.

And with fewer prominent, racially similar role models than blacks and Hispanics -- such as Halle Berry or Jennifer Lopez -- many Asian women become increasingly dissatisfied with their unique look. A 2000 study by Lillian Huang Cummins, postdoctoral fellow at the Addictive Behaviors Research Center at UW's Department of Psychology, found that Asian American college women expressed more body dissatisfaction than Caucasian women.

So they lighten their black hair and tape their eyelids to "fake" a double fold, the crease above the eye that is absent in most Asian faces. Cosmetic surgery, often done to permanently create the double eyelid, is common. The crease allows eyes to look bigger, or at the very least, more Western.

"Because body dissatisfaction is a precursor to eating disorders, it is interesting to note that Asian American women who are unhappy with their bodies point to their ethnic features as being the most troubling of part of their appearance," says Lynn Chang, a doctoral candidate at Colorado State University who researched Asian American body image for her thesis and gives a lecture titled "I Hate My Tummy, I Hate My Thighs, I Hate My Slanty Asian Eyes." "They often cite their hair color, eye color and shape, skin color, body shape, etc., as being most problematic for them."

Not thin enough for the family

Another reason these women turn to eating disorders is the tug-of-war they encounter between their cultures. Whether immigrant or fourth-generation U.S. citizens, Asian American women fight discrimination and stereotypes in this country -- particularly that of the "geisha": submissive, exotic, porcelain-doll delicate and small.

"The basic premise of an eating disorder is an unhealthy reaction to stress," says Chang. "But for Asian American women, being a double minority, i.e. facing sexism and racism, may cause even more stress as a result."

Then there are the battles at home, where women can be compelled to fit the geisha stereotype, said Hue-Sun Ahn, a clinical psychologist and outreach coordinator at Princeton University.

Central to the issue is a trait usually unique to Asian families -- the "shame-based culture." What you do or say affects the reputation of your family. The success of individuals places their parents on a pedestal; those who disgrace the family name are cast out or apologized for. This drive is marked by the observance that Asians are a "model minority," a sociological term coined because of their ability to survive in America through academic excellence, tireless work ethic and strong family bond.

This shame-based attitude also leads to unfair comparisons between children by parents, which leave many feeling angry, humiliated or inadequate. For Ming, it was the way she was sized up to her own mother as well as other daughters who might bring more honor to their family.

"I was also encouraged (to be thin) in some ways by my parents, especially my mother, who had been quite thin as a girl and young woman in Taiwan and who valued her daughter looking 'beautiful.' And who, like many Asian mothers, explicitly compared me, whether in terms of looks, or academic achievement, or whatever, with other girls," she says.

Add to the equation the clash between the family-oriented Asian household and the individualism encouraged in the Western culture. Fearful of losing their children to what they consider a lax world, parents tighten their grip on their children. This environment left Ming, like many girls, wanting to take control of something -- anything. Eating happened to be the thing she could have full control over.

So she started exercising and counting calories, often forcing down half a sandwich or a piece of fruit to keep her parents from nagging. The results were gratifying for Ming: At age 13 she had one area in her life that was entirely her own. She went from a healthy 90 pounds to 75 pounds.

At age 14 she read about bulimics and figured if she tried purging she could control her weight and enjoy food at the same time. In a short time Ming was addicted, eating whatever she could without being discovered -- a carton of ice cream, a bag of cookies -- several times a day and throwing up afterward. By 18, Ming was a success to her family, with an acceptance to Harvard. But she was certainly no longer in control.

Silent cries for help

While the rise of Asian Americans with eating disorders is recognized, it's difficult to gauge accurately how many exist. One reason is because women of color were assumed not to be suffering and therefore not targeted in studies, according to the Office on Women's Health of the U.S. Public Service. Another reason is that the Asian culture traditionally encourages that suffering be hidden and kept within the family -- again, to protect the family image.

"There's a stigma around asking for outside help outside the family," says Hyun Hwang, program manager at Asian Counseling Service in Tacoma. "Mental health services are underutilized. You're just not supposed to talk about it with anyone, particularly a stranger. If an Asian American woman has health problems or symptoms, it's something that (she thinks) perhaps she deserved, something she did that caused her that problem. There's this belief of fatalism, that there's just nothing she can do about it."

So the addiction grows.

"Some Asian families do not have explicit outlets for dealing with negative emotions -- calling for suppression of emotions, or simply a lack of acknowledgement of emotions -- which plays into the need for some girls to find means of dulling inner pain," Ming says, which usually meant more binging and purging.

When she tried to see a counselor in high school, Ming's parents feared news of professional help would stain her permanent record. They also became angry whenever family situations were discussed with an outsider, believing Ming was blaming them for what they perceived as her own "moral failure." Ming grew more withdrawn and didn't tell anyone about her struggles for another seven years.

Many women also have difficulty with the idea of opening up to a white professional, who may not be able to identify the cultural context of her problem. A 1991 study found Asian Americans dissatisfied with Caucasian therapists because they misinterpreted some of their cultural traits -- suppressing emotion and restricting confidence for fear of shame -- as uncooperative behavior. In other instances, any distinct differences between the Asian races -- such as Chinese, Japanese or Korean -- were treated as one race rather than three separate cultures.

In addition, women who are less "Americanized" -- who cannot speak English well -- also may have a problem with counseling because their native language is limited in psychological terms, thereby causing confusion in diagnosis. The term "eating disorder" didn't even have a Korean-language equivalent until two years ago, Ahn said. Patients can feel discouraged after the first visit and choose not to return.

So with Washington state holding the fourth highest percentage of Asian Americans on the mainland (after California, New Jersey and New York), culture-oriented counseling and therapy is necessary -- but surprisingly devoid in number, according to calls made to various Asian cultural and referral service centers. Research could only turn up less than five culture-oriented counseling professionals who deal with eating disorders in the city of Seattle.

"The treatment of eating disorders is a good example (of the need for culture-oriented training)," says Cummins. "If practitioners do not expect that Asian Americans have eating disorders, they may not assess for this."

Luckily, many graduate programs now include training on multicultural counseling. The American Psychological Association requires diversity training in order to receive accreditation and has established standards for multicultural competence so that professionals can understand that therapy expectations are different for people of diverse backgrounds.

"This does not necessarily mean that all therapists will be culturally competent, but we've come a long way from the days when training programs encouraged therapists to be color-blind," Ahn says.

Breaking the pattern

Ming found her own identity at Harvard, away from her parents and pressures of home. She finally took some steps on her own to combat her bulimia. She shared with a boyfriend and a group of friends and through her relationship with God, she says she felt a freedom from her eating pattern.

"I went through a period of consciously allowing myself to experience negative emotions and forcing myself to feel pain, rather than eating to dull the pain. . . . Coming to terms with it was a slow and miraculous process."

Even after Harvard, Ming weathered a smaller battle with bulimia and compulsive overeating. She worked in an Asian American college ministry and met many women with similar family backgrounds and issues. They, too, were obsessed with being thin as part of a greater identity struggle.

"There are many girls who were not able to feel affirmed for who she was, but only what she was perceived to be on the outside. This leads to an internal emotional vacuum, which the girl tries to fill by being perfect, or by eating to the point where she cannot feel her inner emptiness."

Now a full-time mom living in Boston, Ming, 31, says those issues have been behind her for six or seven years. Her family now takes precedence. "I give very little thought to food and body image beyond what to serve the family for dinner."

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